Your Patient Access Management Opportunity

Hospital patient access management solutions can add some great revenue to the mix.

When it comes to boosting hospital’s revenue cycle returns, patient access management is taking a leading role as RCM teams from the CFO on down learn which demographics can pay in full on time. That can largely be done up front, though surveys show that many hospitals are still leaving millions on the table.

“This presents a clear opportunity for hospitals to obtain revenue from accounts that are most likely to be paid in full. More opportunities may exist on such accounts as between one and five percent of self-pay accounts that are written off as a bad debt actually have billable insurance coverage.” — from a TransUnion study that shows hospitals may be leaving millions on the table when their revenue cycle isn’t optimized

20% of Americans are deferring healthcare because of cost, poll finds: We wondered what demographic can pay accounts in full, because this will help our hospital clients. NPR has published an article resulting from research done with IBM Watson, an AI leveraging service with a focus on healthcare. NPR editors write that, “we also asked people if they – or members of their household — had difficulty paying for some kind health care service in the preceding three months. A quarter said yes. And again the strain varied by age, with 41 percent of people under 35 saying they had experienced difficulty while only 11 percent of people 65 and older had.”

Meanwhile, “Nine organizations representing consumers, businesses and health insurance providers revealed they are banding together to protect patients from surprise, unexpected medical bills,” reportedBecker’s Hospital Review. We had a look at the AHIP — America’s Health Insurance Plans — statement about the group mentioned by Beckers and it looks like it has assembled a powerful coalition including the Consumers Union (publishers of Consumer Reports “An independent, nonprofit member organization that works side by side with consumers for truth, transparency, and fairness in the marketplace”, The ERISA Industry Committee, and Families USA, a group whose mission is to be “the voice for healthcare consumers”.

Further down in the news release from AHIP, we see statements about what the coalition wants, like this one:

“Patients who are doing the right thing, going to in-network hospitals, often are surprised when doctors or hospitals send them large, unexpected bills. Companies that sponsor health plans for their employees believe that it is imperative that we protect patients from these bills, and that we do so by eliminating the bills – not forcing someone else to pay, rewarding providers who want to charge without regard to networks, contracts or patient care. Next year Congress has an opportunity to truly solve this problem.” – Annette Guarisco Fildes, President and CEO, The ERISA Industry Committee

Is this focus on easing “surprise bills” the best thing for Hospitals? Beckers deals with that question by noting that, “Federation of American Hospitals President and CEO Chip Kahn and American Hospital Association President and CEO Rick Pollack said the alliance is mischaracterizing the root of the issue.” They report those CEOS have stated that, “inadequate health plan provider networks that limit patient access to emergency care is one of the root causes of surprise bills. Patients should be confident that they can seek immediate lifesaving care at any hospital.”

Heading off Patient Access Management Problems up Front

What can hospitals make of all this turmoil? As a TransUnion Healthcare analysis found that “30% of self-pay accounts – those patients without health insurance or those that have a patient balance after insurance – will generate more than 80% of the self pay revenue collected by hospitals. TransUnion released this information as part of a campaign to highlight the importance of healthcare insurance discovery.”

And, insurance coverage has been declining which impacts the ability to pay. “The findings are significant because the number of patients without health insurance increased to more than 12% at the end of 2017. Furthermore, Patient Balances after Insurance (PBAI) have been steadily rising – increasing from 8% of the total bill responsibility in Q1 2012 to 12.2% in Q1 2017.”

That’s the bad news. The good news is that smart hospital patient access management can head off problems up front. We’ve covered this at some length in a recent article on “Winning the Battle: Hospital Patient Access Best Practices“. We are working with hospital clients to provide the right information and tools via our SSI Access Director solution which helps patient access teams focus their efforts on addressing front-end revenue leakage by moving tasks completed by the billing office to the front-end of the revenue cycle.

Nick Davis, Vice President, Product Management – Patient Access at The SSI Group, LLC observes, “We see our hospital clients struggling to upgrade both their systems and processes to help patients unable to pay in full for services. In our thinking for a solution, we focus on smart ways to get ahead of the curve up front — in patient access — so that teams can head off potential roadblocks before they impact revenue capture and patient satisfaction. Imagine giving a new patient a comprehensive cost of care estimate up-front while an internal tool assesses ability to pay, so your financial people can offer payment options tailored to their situation— before treatment even begins .”

Imagine that. We reviewed another article at Becker’slisting five things to know about surprise medical bills from a hospital CFO standpoint. What if patients were told what to expect at point of service, instead of being hit with bills weeks and sometimes months after their hospital visit? Here are three things from that article we believe could be communicated up front:

Nearly 70 percent of individuals with unaffordable out-of-network medical bills did not know the healthcare provider was not in their plan’s network at the time of care.

Of surprise medical bill complaints received by New York insurers and HMOs, roughly 90 percent concerned medical bills for non-emergency services including bills for anesthesiology, lab services, surgery and radiology.

But you can’t solve those issues until you have a system in place. Revenue Cycle Intelligence has a recent article out on how 26% of Hospitals are without a workable revenue cycle management system. This means that “82 percent of the hospitals plan to go blind with value-based reimbursement and 85 percent may seek consulting services.”